Provider Demographics
NPI:1437745288
Name:HARTIGAN, PATRICK M (HIS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:HARTIGAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 INDEPENDENCE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2211
Mailing Address - Country:US
Mailing Address - Phone:757-687-6643
Mailing Address - Fax:
Practice Address - Street 1:624 INDEPENDENCE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2211
Practice Address - Country:US
Practice Address - Phone:757-687-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002392237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist